Presentation
Patient presents with vague abdominal pain for several months.
Patient Data
Large hypoechoic fluid containing cystic lesion in the right adnexum containing numerous large 1-2 cm hyperechoic masses likely representing globules of fat and sebaceous material freely floating within an ovarian dermoid cyst. Based on size, surgical consultation is recommended.
Case Discussion
Cystic teratomas are one the most common benign ovarian neoplasms for females of reproductive age. They contain early embryologic tissue from the endoderm, ectoderm and mesoderm. They have often been found to contain, fat, sebum, hair and teeth which has been well documented. It is still unclear how these fat globules form within the cyst. It has been hypothesized that they are formed by an aggregation of sebaceous material around a nidus which results in multiple concentric layers. The lower specific gravity of the of the globules relative to the intracystic fluid allows for their motion within the cyst.
These multiple intracystic fat globules are another way in which a common diagnosis is presenting uncommonly. Other ultrasonographic features such as the tip of the iceberg sign, mesh sign (which was also present in this case), and Rokitansky’s nodule have been well described. This is another uncommon manifestation that could be added to the other signs that are pathognomonic for a mature cystic teratoma.
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